Superior mesenteric vein thrombosis after colectomy in a patient with Crohn's disease
Andrew S Ross1, Arunas Gasparaitis, Roger Hurst
1Department of Surgery, University of Chicago, IL, USA.
Insights
A young woman with Crohn's disease developed acute mesenteric ischemia due to superior mesenteric vein thrombosis. Prompt surgical intervention and anticoagulation were crucial for managing this rare complication.
Area of Science:
- Gastroenterology
- Vascular Surgery
- Internal Medicine
Background:
- A case study of an 18-year-old female with a history of Crohn's disease.
- Initial misdiagnosis of ulcerative colitis, followed by a colectomy.
- Subsequent diagnosis of Crohn's disease confirmed via ileoscopy and biopsy.
Observation:
- The patient presented with severe epigastric pain, nausea, and vomiting.
- Exploratory laparotomy revealed acute mesenteric ischemia.
- Superior mesenteric vein thrombosis was identified as the cause.
Findings:
- Surgical resection of necrotic bowel was performed.
- Treatment included broad-spectrum antibiotics and systemic anticoagulation.
- The patient's condition stabilized post-intervention.
Implications:
- Highlights a rare but serious complication of inflammatory bowel disease.
- Emphasizes the importance of considering vascular events in IBD patients with acute abdominal symptoms.
- Underscores the critical role of multidisciplinary management in complex cases.
Background:
An 18-year-old woman with a history of Crohn's disease presented in January 2004 with severe epigastric pain, nausea and vomiting of 4 hours' duration. The patient was diagnosed with inflammatory bowel disease, thought to be consistent with ulcerative colitis, in March 2003, but had no medical history up until this point. Initial treatment with mesalamine was unsuccessful and she subsequently presented with medically resistant fulminant colitis and required an urgent colectomy in June 2003. Her immediate postoperative course was uneventful and she was discharged on tapering doses of prednisone. In August 2003, an ileoscopy revealed inflamed, mildly ulcerated mucosa, and biopsies were consistent with Crohn's disease. Azathioprine was added to the treatment regimen and the patient tapered off prednisone. At this stage the patient continued to do well clinically up until presentation.
Investigations:
Small bowel series, abdominal CT scan, abdominal ultrasound, exploratory laparotomy.
Diagnosis:
Acute mesenteric ischemia secondary to superior mesenteric vein thrombosis.
Management:
Resection of necrotic bowel, antibiotics and systemic anticoagulation.
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